Feng Dongxu, Zhang Jun, Zhu Yangjun, Wu Shufang, Shan Junping, Ye Aiming, Wang Zhan, Gao Tianqi, Wang Hao, Zhang Kun
Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine Center for Translational Medicine, the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an Department of Orthopaedics, Da Li County People's Hospital, Weinan, Shaanxi, China.
Medicine (Baltimore). 2018 Aug;97(35):e11974. doi: 10.1097/MD.0000000000011974.
Longstanding humeral shaft nonunion is uncommon because humeral shaft fractures often respond well to conservative and surgical treatments. However, when it occurs, the treatment of longstanding humeral shaft nonunion is challenging. This study is a retrospective analysis of the clinical and radiographic findings in a consecutive series of patients with longstanding humeral shaft nonunions who underwent locking compression plate (LCP) fixation and autogenous iliac crest bone grafting.Six patients were surgically treated at Xi'an Hong Hui Hospital for longstanding humeral shaft nonunions between February 2011 and June 2015. Four patients were of synovial pseudarthrosis, 1 was atrophic, and 1 was hypertrophic. Follow-up was for at least 12 months after intervention. Standardized treatment included a thorough debridement, LCP and screw fixation, and autogenous iliac crest bone grafting. In 3 patients, a single plate was applied, and in the other 3 patients, double plates were used. The main outcome measurements were shoulder and elbow function (Constant and Murley scale, and Mayo elbow performance index [MEPI]) and the visual analog scale (VAS) for pain. In addition, all complications were documented.Our series included 6 male patients with an average age of 56.3 years and an average nonunion duration of 19.5 years. All patients had previously undergone at least 1 operation. At a mean of 26 months follow-up, all fractures had achieved solid union and none of the implants had evidence of loosening or breakage. Postoperative alignment was within 10° of anatomic in 4 patients, 1 patient had 23° of valgus angulation, and 1 patient had a posterior angulation of 12°. Mean humeral shortening was 2.8 cm. The mean Constant and Murley joint function score was 88.3 points, the mean MEPI was 96.7 points, and the mean VAS was 0.7. All patients reported significant improvement in shoulder and elbow function, and each patient was able to resume work and was satisfied with the treatment.Plate fixation combined with autogenous iliac crest bone grafting is an excellent option for the treatment of longstanding humeral shaft nonunion.
长期肱骨干骨不连并不常见，因为肱骨干骨折通常对保守治疗和手术治疗反应良好。然而，当它发生时，长期肱骨干骨不连的治疗具有挑战性。本研究是对一系列连续的长期肱骨干骨不连患者进行锁定加压钢板（LCP）固定和自体髂嵴骨移植后的临床和影像学表现进行的回顾性分析。
2011年2月至2015年6月期间，6例长期肱骨干骨不连患者在西安红会医院接受了手术治疗。4例为滑膜假关节，1例为萎缩性，1例为肥大性。干预后随访至少12个月。标准化治疗包括彻底清创、LCP和螺钉固定以及自体髂嵴骨移植。3例患者应用单钢板，另外3例患者应用双钢板。主要观察指标为肩肘功能（Constant和Murley量表，以及梅奥肘关节功能指数[MEPI]）和疼痛视觉模拟量表（VAS）。此外，记录所有并发症。
我们的系列研究包括6例男性患者，平均年龄56.3岁，平均骨不连持续时间19.5年。所有患者此前至少接受过1次手术。平均随访26个月时，所有骨折均实现牢固愈合，且无植入物松动或断裂迹象。4例患者术后对线在解剖位置10°以内，1例患者有23°外翻成角，1例患者有12°后成角。平均肱骨短缩2.8cm。Constant和Murley关节功能评分平均为88.3分，MEPI平均为96.7分，VAS平均为0.7分。所有患者均报告肩肘功能有显著改善，且每位患者都能够恢复工作并对治疗满意。
钢板固定联合自体髂嵴骨移植是治疗长期肱骨干骨不连的极佳选择。
